Characteristics Data Form - Floatation System Facility Construction Permit Application
Characteristics Data Form
Floatation System Facility Construction Permit Application
This form must be filled out for each individual floatation system. If you have two or more identical floatation systems, you may fill this out only once. However, a unique identifier (floatation system) must be provided for each of the identical systems.
Send this form and other required application items to:
WA Department of Health
Water Recreation Program
243 Israel Road SE
Tumwater, WA 98501
Address Line 1: / Contact Name: / Phone:
Address Line 2: / Email: / Fax:
Facility Information
Facility Name: / Contact Name:
Physical Address:
Email: / Fax: / Phone:
Floatation System Characteristics Data
Unique Identifier / Floatation System Type
This is the name or number that you assign to each floatation system. If you are filling this form out for multiple identical systems, list all the unique identifiers for them here. / FOR OFFICE
USE ONLY
Database Identifier
☐Pod: / a premanufactured system that you purchase and install on site.
☐Cabin: If so,☐site-built system, or ☐premanufactured
☐Other (explain):
Manufacturer:
(n/a if site-built)
Model:
(n/a if site-built)
Floatation System Characteristics Data (continued)
Volume / Filter
The normal volume of the float water when the tank is filled. / ☐gallons, or
☐liters / Manufacturer:
Target Float Water Temperature: / ☐˚F, or
☐˚C / Model:
Target Float Water
Specific Gravity:
Pump / Media Rate: / ☐gallons per minute/ft2, or
☐liters per minute/m2
Manufacturer: / Filter Area: / ☐square feet, or
☐square meters
Model: / Horse Power: / Size of suspended particles removed: / (microns)
Recirculation Data / Duration of Recirculation:
(minimum time between bathers) / (minutes)
Clean FilterFlow Rate: / ☐gallons per minute, or ☐liters per minute / Design Volumetric Turnovers*: / (turnovers)
*Turnovers = Dirty Filter Flow Rate x Duration of Recirculation÷ Volume /
Dirty Filter Flow Rate: / ☐gallons per minute, or ☐liters per minute
Treatment Methods Employed
UV Device: ☐Yes ☐No / Ozone Device: ☐Yes ☐No
Manufacturer: / Manufacturer:
Model: / Model:
Maximum Recommended Flow Rate: / ☐gpm
☐lpm / Ozone generation: ☐UV, or ☐Corona Discharge Method
UV Dose: / (mJ/cm2) / Maximum Recommended Flow Rate: / ☐gpm
☐lpm
Target Ozone Concentration in Float Water: / ☐ppm
☐mV*
Salt Chlorine Generator: ☐Yes ☐No / *Oxidation-Reduction Potential
Manufacturer: / Advanced Oxidation Device: ☐Yes ☐No
Model: / Manufacturer:
☐In-Line Generator, or ☐Brine Tank Generator / Model:
Target Free Chlorine Concentration in Float Water: / ☐ppm
☐mV* / Maximum Recommended Flow Rate: / ☐gpm
☐lpm
*Oxidation-Reduction Potential